Polymyalgia Rheumatica

Thank you, Marilyn, for pointing out a very important condition missing in my website. This website is a community project. Please comment if you see anything missing or something you don’t agree with. The comments don’t appear, but I will answer them in the blog. I can’t always do this in a timely manner, as I am still working as a physician, but I will do my best.

Polymyalgia rheumatica is an inflammatory disorder causing muscle and joint aches and stiffness across the neck, both shoulders and pelvis. It develops gradually over a few weeks to months and often will come with fever, loss of appetite and fatigue. 

The exact cause is unknown, but likely due to genetic markers, or infection, or both. 

Those affected will be over the age of 50, usually over 70 and more often female and of European descent. The episodes are longer than 2 weeks and cause morning stiffness for more than 45 minutes. These symptoms are usually better later in the day, compared to osteoarthritis which can become worse towards evening.

Muscle weakness can occur because of pain. The pain is worse with movement and can radiate through the fascia of the arms and legs and into bursa (these are protective cushions around the joints.) The hands and feet can also hurt. 

Before the diagnosis is made, a good history and investigations need to be performed. Infection, malignancy, and giant cell arteritis, (temporal arteritis causing severe headache, scalp tenderness, later visual loss, stroke, even death) need to be excluded.

Apart from an examination for tenderness and other causes, bloods will need to be drawn: A Full or Complete Blood Count; C reactive protein – which is usually moderately raised, Liver function tests and electrolyte and creatinine testing as cortisone is used in the treatment of PMR.

Additional testing includes:

TSH for fatigue, Rheumatoid Factor and, if positive, anti CCP (anticyclic citrullinated peptides) which are raised in rheumatoid arthritis. CK for muscle disease like polymyositis, and ANA (antinuclear antibodies) for autoimmune disease.

A rheumatologist can be invaluable in excluding disease like RA.

Corticosteroids are powerful anti-inflammatory drugs, more powerful than Non-Steroidal Anti-inflammatories (NSAIDs) but they do carry the risk of more serious long term side-effects, like skin changes, bruising, mood changes, osteoporosis, aggravation of diabetes, hypertension, cataracts, glaucoma, fluid retention and heart failure, and increased risk of infection. A basal bone density test – an X-ray to assess fragility of bones – is important.

Usually 15mg for three weeks, then slowly tapering as tolerated, usually 10% every couple of weeks. Reducing the dose must take place over a long period of time with slow reductions over many weeks.

Vitamin D is vital – a supplement always in winter in cold climates with little sun, and more so with cortisone. Bisphosphonates and other osteoporosis meds can be considered if indicated. Gastric side effects can be decreased using proton-pump inhibitors.

Managing PMR requires medical and self care. The self care is important. Any load – physical or emotional – that overloads the body can increase inflammation. Gentle exercise and stretching, mindfulness, (look for Palouse mindfulness further down the page), restorative breathing, all help towards moving towards healing. 

Take care all


Stress vs Anxiety

Physical stress and emotional stress is the biggest reason for inflammation in the body. Inflammation in your bladder (cystitis) in your stomach (gastritis) in your brain (brain fog and dementia) in your heart (SCADs heart attacks). The limbic system doesn’t differentiate (see the difference) between physical and emotional stress.

For example, the ten years before menopause, hormonal fluctuations cause physical stress. SCADS Spontaneous Coronary Artery Dissection – where the walls of the arteries in your heart split – the cause of 30% of heart attacks in women under the age of 50 – all due to added physical stress load on the body.

Last week, I had a patient present with urticaria – her whole body was covered with raised red freakishly itchy patches. She couldn’t cope. The medications, even Prednisone, was not working. (Prednisone is a very strong anti-inflammatory drug).

We went through all the possible reasons, but I didn’t mention anxiety. (My patients are fed up with my talking about anxiety anxiety anxiety). She brought it up. She’d had a disturbing experience before the rash appeared. She commented on my site (comments are hidden) how the rash improved almost immediately with the program below. I reminded her to look at the rash and imagine if this was what was happening on her skin, imagine what is happening inside the body.

Stress doesn’t only affect the body. It also affects the mind. Causing anxiety, depression, inattention, brain fog, . . . the list goes on.

We all have stress. Anxiety is when the stress load is too much and the body is overwhelmed.

Take care. Use your Body to Calm the Mind


Losing Weight

A healthy self image is very important to enjoy a good quality of life. We place far too much emphasis on how we look. Enjoy the body you have. Don’t chase the Kate Middleton and Mylie Cyrus looks. Look to role models that suit your body.

However, if you are obese, it can compromise your health. Living well and nourishing your body is important. But not always easy. Don’t believe it’s only about what you eat.

I’ve always been chubby, not really – since the age of about ten really, but I am happy with my body. It serves me very well. I am also lucky, because I should have been obese. I use food for comfort. To celebrate. When I’m bored. Any emotion that makes me feel uncomfortable has me thinking – fooooood. Especially carbs that are easy to digest because that is what my freaked out brain desires. Chocolate . . .

Luckily for me, my stress response is a Fight (not so lucky for others) response. My limbic system gears up to run, to fight, and my hormones set my metabolism on fire. So I remain overweight, but not obese. Phew!

For those of you who are obese, more than likely, you have a freeze response to stress. Your metabolism is a super saver. It shuts down to hoard calories (kilojoules), storing energy as if you are about to enter the ice age. Or more likely now, global meltdown. Oops now I’ve stressed you out more. Feel those calories bloating up your body.

What to do? Of course, eating healthily is essential. The Mediterranean diet or a combination of Keto and Mediterranean can be found on Diet and Lifestyle. Of course, consult your healthcare provider first. And another obvious ingredient would burning calories – Exercise. But what to do if you don’t have the motivation (because of freeze response)?

I discuss these issues not to help you lose weight, so much as to help you find a path of balance in your life. To find balance, we have to take care of hidden stress or poor self-image problems. What we feel about ourselves and our bodies can be a reflection of hidden issues.

To improve a balanced approach to life, take a look at Ways you can use your body to calm your stress response. These exercises are like body building exercises for the mind. They will make you stronger. Help you concentrate. Help you enjoy a better life.

Remember we are social animals. We need others to balance our lives. Also pay attention to spiritual matters. A healthy mind, body, spirit will keep you strong.

Good Luck


I’m over it!

It’s in the past. I don’t want to dwell in the past. I have to move forward.

These are great sentiments. Living in the moment is very healthy. But do search your body to see if another part of your brain is stuck in the past.

If you’ve had difficulties ‘attaching’ to your mother, or if you mother was distant, or damaged from past traumas, this could be stuck in your limbic system.

Do a body scan once a day. Daily Program. 5 minutes.

Notice – Notice do I fidget a lot – fidgeting or not being able to sit still is like the steam whistling when the water is boiling in a kettle. It is your body’s way to tell you that your are uncomfortable.

I believe we have 3 brains. The thinking part of the brain – Cortex. That’s the part that tells you nothing is wrong. I’m fine. Leave it alone.

The limbic system is the part damaged in trauma. That damage causes inflammation, over-reactions to food, or toxins. Around menopause time inflammation can cause heart attacks – even strokes. Or high blood pressure or diabetes.

The third part of the brain is the celiac plexus in your gut. You can get colitis, irritable bowel syndrome, constipation, diarrhoea, bloating, abdominal pain.

Each of us has a body part or parts that respond differently to stress. I used to be a snot factory, my sinuses poring out disgusting green secretions. Others have fibromyalgia or other problems. Stress switches on the genes that causes these diseases. The more stress, the more likely the disease acts up.

All the more reason to use the body to Calm Down.

Good luck


Poor Sleep?

Sleep is vital but our minds sabotage our sleep.

There are 3 great tips I read in Medium.

  1. Write down everything you can think about that’s worrying you before you go to sleep. Scribble. It doesn’t matter what it reads like. Just write. Then slam the book closed and pack it in the drawer. Done!
  2. Practice your breath – in for the count of 4, hold for 2, out for 6 to 8, hold for 2 and repeat. focus only on your breath. When the mind moves, gently bring it back to your breath.
  3. If you still can’t sleep, focus on not worrying about whether you are going to fall asleep or not. Remember that if you relax and breathe, it is the same as sleeping. Not really. But you can fool your brain.
  4. One trick I read from Medium article, Choose a work, like any word with at least 5 letters, say Scapegoat – then start with the first letter and think of as many words as you can starting with the letter S, then move do C, then A, and so on. I find this works very well. It tricks the brain. An overactive brain needs exercise and this has helped me fall asleep.
  5. Whenever I have a problem falling asleep, I do the Evening Qi-Gong exercise. Very easy. Can even be lazy and do in bed. Daily Program and Ways to Calm Down.
  6. Here are more tips. Sleep Tips.

Take care. You are worth it.


Waking up tired? Or tense?

If we have trauma or lots of stress (like chronic pain or illness – remember the physical stress is the same as emotional stress on your Limbic system) where was I, okay, when we wake up after a night of stress, our cortisol levels are high.

High cortisol causes – Fatigue, Weight gain, easy bruising, swelling, especially the legs, mood swings, mental fog, muscle weakness, potassium to go down, it lowers your bodies ability to fight infection.

Where does the cortisone come from? Stress causes a rise in Adrenaline – which is the hormone meant to protect us from dying – like say you are lying on the street bleeding out – your body reacts by pushing out Adrenaline to raise your blood pressure and pulse. It also causes release of anti-diuretic hormone – ADH – from the Limbic system. This is all to keep your blood volume up.

The body reacts to ANY stress as if you are bleeding out. Or as if you need to get ready to fight or flee. So now if the Adrenaline is up for more than 3 days, Cortisone starts to go up. Cortisone is from your adrenal glands.

Your body needs to feel safe. Many of us don’t feel safe. Especially today. No money. The plague is causing havoc. There is lack social contact. There is distrust in the medical system. In every system. We’re all a little fed up.

What can we control? Only ourselves. Start with little baby steps. Ways to Calm down. If you can’t do everything you want to, give yourself a break. Be curious. What is stopping me from doing the work to get better? The last thing you need is judgement. Be kind to yourself and others.

Ways to Calm down

Take care


When is Laughter too Much?

Jackie has severe fibromyalgia. She has been ill for many years but I had no idea just how ill. She always visits with a happy smile and a laugh. She almost never complains, and when she does complain, she minimizes her symptoms. Jackie never thought her pain was significant. She felt it was normal to have the amount of pain she has.

Jackie’s parents have anxiety and anxiety leads to control issues. They have therefore obsessive traits, expect perfection, and hard work is a must. They adhere to these expectations and expect the same from their children. Because of this, as a child, Jackie has a high shame response. Because we ARE never good enough.

Jackie is like me, lucky enough to be born with a happy temperament. She responded to the high expectations with vigor and was eager to please her parents. Up to now, this has led to people pleasing.

People pleasers usually expect more from themselves and blame themselves more. Jackie has therefore done everything she could for herself to get better. Asking for help, makes her feel shame, or that she is inconveniencing others.

Where does Jackie’s laughter come from?

  1. When she is surprised or caught unawares – a form of stress.
  2. When she is told something and then realizes, Wow, that’s right. Immediately Jackie thinks, Why didn’t I think of that? Laughter then is a shame response.
  3. When she is uncomfortable, she will laugh, especially around other people, because she doesn’t want them to be uncomfortable or to realize she is uncomfortable.
  4. Jackie shares her mother had a very difficult childhood and she mostly showed anger or laughed. Her mother was emotionally shut down to cope with her childhood. Maybe Jackie needed excess emotions to penetrate her mother’s barriers.
  5. Of course she laughs when she feels joy, but most of her laughter is to cover up her discomfort.

I am sure you can find other reasons for laughter. Laughter is very good for you, but not if you are using it to mask pain, emotional or physical.

Jackie is going to practice Step 2. Changing from “preparing for danger” breath to healing breath will help her notice when she is stressed – laughing too much, talking too fast, or too loudly.

Jackie will examine her reactions with curiosity, not shame or judgement. Feel your emotions in your body.

Notice the moment when you laugh or when you are speaking too quickly or too loudly.

The journey begins.


Jeannie’s Plantar Wart

For Jeannie’s Wart. Darn stubborn virus is not responding to Compound W or cryotherapy. Let’s try Cariboo Chrome:

  1. Apply a small piece of duct tape directly to the area of your wart and continue as normal. You can walk on it and exercise. 
  2. Every 3 to 5 days, remove the duct tape. Gentry rub the wart with an emery board or pumice stone. Stop immediately if it bleeds as the virus spreads with bleeding.
  3. Repeat step 1. after about 12 hours of air time. 

Fibromyalgia and genetics

We are now learning rapidly how fibromyalgia can be linked to epigenetics. What on earth is epigenetics?

Previously we thought our genes were fixed. That the information coded on our genes is permanent. Now we have learned that only 4% of the information in our genetic coding is fixed, for example, the color of our skins, hair, eyes.

How are bodies are made can be changed even in third trimester of your mother’s pregnancy. If your mother has severe stress – physical or emotional – then a chemical reaction can occur that changes your genetic profile.

There are proteins and chemical reactions that happen to molecules attached to your genes. These changes are like a key and a lock. With stress, the reaction can be like a key that opens the door to changes in your body. For example, an inflammatory gene can be switched on. This inflammatory gene is coded to cause different types of inflammation in your body.

The changes can also cause diabetes, high blood pressure and even cancer genes can be switched on by these epigenetic changes.

There are now many scientists working on epigenetics. The ways our body is affected by stress or toxins in our environment.

The good news is, that many of these changes are temporary. We can change our futures. Use tools to lower inflammation. Ways to calm the Limbic System is one of them.

More to come as we learn more

Take care


POTS Postural Orthostatic Tachycardia Syndrome

POTS is a recognizable provable condition. Measure your heart rate and blood pressure sitting, or better yet, lying down. Then compare them to standing. Measure readings every 3 minutes from 1 minute after standing and if your heart rate rises by over 30%, you likely have POTS.

Before reading further, remember this is not a substitute for regular care. Be sure to consult a health care provider to exclude other causes, like dehydration, anemia, hormonal abnormalities, or side effects from drugs.

Some people then have an instant rise in pulse or a drop in blood pressure. POTS is when only the pulse changes – usually going up by 30% from baseline. The blood pressure can drop, or go up, but not change significantly. In that way, it differs from orthostatic hypotension – big mouthful – orthostatic low blood pressure: when your blood pressure drops too much when you stand or change your position. The limbic system regulates blood pressure and heart rate.

We are not sure what causes it, but I believe an upset that affects the limbic system causes it. The upset can be physical, as in viral infections, an autoimmune disorder, or some other toxic attack on your brain’s regulatory center.

Anxiety is also an inflammatory disorder causing inflammation in your brain. I believe limbic trauma – adult or childhood adverse events – can lead to POTS. Here, triggers can be subconscious – you can see something that triggers memories and not even know it. Other triggers can be bright lights, a certain taste or sound, fatigue, sight of blood, or any physical or emotional stress, usually emotional.

No matter the cause of POTS, whether physical or emotional, the syndrome is not in your head. The effects of POTS are very real and very disruptive. Calming the limbic system can help improve POTS signs and symptoms, regardless of the cause.

I have a patient with me today, helping me discuss POTS. She explains that when she’s focused on anything serious, especially when she is helping somebody, her symptoms improve. When working or helping a person, her performance improves. She is stronger and overexerts herself, unfortunately suffering afterwards.

Being able to do more some days or some parts of the day is puzzling. Part of this may be an adrenaline surge. Definitely, when less stressed, a person has fewer symptoms. When distracted, the brain is occupied with other things. Distraction can improve symptoms.

Beware of overexertion. Pacing is very important. More pain causes more fatigue and erratic heart rates.

Patients with POTS may have tremors, headaches, migraines, chronic fatigue syndrome, fibromyalgia, autoimmune disorders, allergic conditions, or celiac disease.

Speak to your health care professional before trying any of the treatments.

Water – 3 liters per day; Salt – 5ml (2 teaspoons per day) Waist high compression garments.

Propranolol can be used, usually 10 to 20mg four times a day, but more recently other medications, like midodrine 5mg every 4 hours, three times a day or ivabradine 5mg twice a day if propranolol contra-indicated.

Inflammation needs to be treated. Speak to your health care provider. Use the body to calm the Limbic System.

If you have severe past emotional trauma, you need counselling, maybe even EMDR therapy. 

Low impact exercise is vital. Try the QiGong and Yoga on the link above calming the limbic system. 

Good luck and take care